Table 3.

Treatment regimens for hypercalcaemia of malignancy^a

Medication	Dosing	Adverse effects
Intravenous bisphosphonates
Zoledronic acid	4 mg IV infusion over 15–30 min. Can be repeated after 7 days if required and every 3–4 weeks thereafter Renal dosing: 3 mg over 30 min if CrCl 30–60 mL/min; C/I if CrCl <30 mL/min	Infusion reaction Renal impairment Hypocalcaemia ONJ and AFF (rare)
Pamidronate	90 mg IV infusion over 2 h. Can be repeated every 2–3 weeks Renal dosing: 60 mg over 4 h if CrCl 30–60 mL/min; C/I if CrCl <30 mL/min	Infusion reaction Renal impairment Hypocalcaemia ONJ and AFF (rare)
RANKL monoclonal antibody
Denosumab	120 mg SC injection; repeat after 1, 2 and 4 weeks; monthly thereafter	Injection site reactions Hypocalcaemia ONJ and AFF (rare)
Other treatments
Salmon calcitonin	4–8 units/kg SC TDS or QDS for 2–3 days	Tachyphylaxis after 2–3 days
Hydrocortisone (HC) Prednisolone (P)	HC: 200–400 mg/day for 3–5 days P: 60 mg/day for 10 days	Hyperglycaemia Hypertension Mood alterations
Cinacalcet	30 mg BD initially, titrate to maximum dose 90 mg TDS or QDS	Nausea/vomiting Headaches

^aReproduced, with permission, from Oxford University Press.⁷

AFF = atypical femoral fracture; BD = twice daily; C/I = contraindicated; CrCl = creatinine clearance; IV = intravenous; ONJ = osteonecrosis of the jaw; QDS = 4 times/day; RANKL = receptor activator of nuclear factor kappa-B ligand; SC = subcutaneous; TDS = 3 times/day.